435202710-7-22-2021-26-AS-SYIP-C5LUBJ-20210805152626

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202710
Report Date: 07/22/2021
Date Signed: 07/22/2021 04:17:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2021 and conducted by Evaluator Anna Bui

COMPLAINT CONTROL NUMBER: 26-AS-20210714100229

FACILITY NAME:	VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE		FACILITY NUMBER:	435202710
ADMINISTRATOR:	WILLIAMS, RYAN		FACILITY TYPE:	740
ADDRESS:	20388 SARATOGA LOS GATOS RD		TELEPHONE:	(408) 741-2950
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	74	CENSUS: 32	DATE:	07/22/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Karen Padilla		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not seek medical attention for resident in a timely manner
Staff are not providing adequate food service to resident
Staff are not treating residents equally
Staff are engaging in inappropriate behaviors with residents
Staff dropped resident
Staff are not properly quarantining residents

INVESTIGATION FINDINGS:

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On 07/22/2021 at 12:45 pm, Licensing Program Analyst (LPA) Anna Bui conducted an unannounced initial 10-day complaint investigation visit for the above allegations. LPA met with Karen Padilla, Clinical Coordinator.

During today’s visit, LPA interviewed 4 staff (S1-S4) and requested documents. 4 out of 4 staff stated there has been no residents from Assisted Living that has complained about the allegations listed above. 4 out of 4 staff confirmed the alleged victim (R1) has never been a resident of the facility’s Assisted Living (AL) side but is a resident of the Skilled Nursing Facility (SNF). S2 stated R1 was discharged from SNF to another acute care hospital.

-Continued, see LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20210714100229

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: VILLAS AT SARATOGA SKILLED NURSING & ASST LVG, THE	FACILITY NUMBER: 435202710
	VISIT DATE: 07/22/2021

NARRATIVE

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A review of the facility’s records confirmed the alleged victim (R1) was not a resident of the facility’s Assisted Living building.

This facility is a Residential Care Facility for the Elderly, and this facility has both an Assisted Living (AL) and Skilled Nursing Facility (SNF). SNF is regulated by the Department of Public Health.

The Department has investigated the above allegations. Based on interviews conducted and documents reviewed, the Department found the above allegations to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies were cited during today’s visit.

Exit interview was conducted with Karen Padilla, Clinical Coordinator. This report was reviewed with Karen Padilla, Clinical Coordinator, and a copy was provided.

SUPERVISOR'S NAME: Sarah Yip	TELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Anna Bui	TELEPHONE: 650-269-7419
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021

LIC9099 (FAS) - (06/04)

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